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Tuesday, 20 December 2011

Coley's Toxins In The UK

Coley's Toxins is an cancer therapy from the pre-history of modern oncology. Developed by surgeon William Coley at the end of the 19th century, this was a treatment that showed some impressive results against a range of hard to treat cancers - especially sarcomas. Coley began the treatment after noticing that some patients with cancer experienced tumour regression after becoming infected in hospital. These rare cases of spontaneous remission were regarded as miracles, which they still are, pretty much. The infected patients would develop severe fevers, chills, aches and pains and the rest of the signs of a massive immune response that ended with the tumours being attacked by the immune system.

Coley took this idea forward and developed a treatment that consisted in inducing this severe immune response by injecting bacterial material into his patients. The patients reacted to this injection of 'bacterial toxins' by developing the feverish response as their immune systems kicked in. And, in some cases, the resulting immune response did indeed lead to the tumours being attacked and ultimately disappearing. This did not happen in all patients, but it happened at a rate that is comparable to some of the more modern cancer treatments. And, it must be said, because the tumours were cleared by the immune system, there were none of the long-term side-effects you get from chemotherapy or radiotherapy, and in many of those individuals where the tumours disappeared the treatment really did lead to a cure.

However, with the advent of radiotherapy, chemotherapy and advances in surgery, Coley's treatment fell by the way-side. Coley is often credited with being the 'grandfather' of cancer immunotherapy, but largely his treatment barely exists as a historical footnote in oncology. There is still a fair degree of interest in it from those interested in alternatives, but in the mainstream of medicine Coley's toxins are dead. However, outside of the mainstream there have long been a few doctors interested in using Coley's and in trying to bring it back as a viable treatment. For those patients who have exhausted all conventional treatments, it's an alluring prospect. This was the situation we found ourselves in after my son's treatment options had all been exhausted. George's osteosarcoma was still progressing when the last curative treatments had failed - by this time George had endured multiple surgeries, photodynamic therapy and many different forms of chemotherapy. I did the research and discovered that a company in Canada (MBVax) still produces Coley's Toxins. I contacted them and they put me in touch with a doctor here in the UK - Dr Henry Mannings of the Star Throwers cancer charity.

After a number of discussions Henry agreed to try and import the Coley's vaccine, (not a live vaccine, by the way, but manufactured from bacterial fragments), into the UK in order to try it on George. It took many, many months before he succeeded in getting the MHRA to agree to it coming in. By the time Dr Mannings was in a position to treat him, George’s condition had worsened considerably. It was touch and go as to whether he would be treated, but George was adamant he wanted to try it. There were no other options open, none at all. We managed to persuade Dr Mannings to go ahead, and George became the first UK patient in recent years to receive Coley's in this country. It was small consolation, but George was proud to be a pioneer.

Sadly George's condition was so far advanced that there was little prospect of the treatment doing very much. We tried, and for a while there seemed to be some slight response in terms of tumour shrinkage, but in the end even this was reversed and the disease progressed rapidly.

There are many false impressions about Coley's, particularly amongst those who view it as a long lost cure for cancer. As we have repeatedly stressed on this site, there are no miracle cures for cancer. Coley's is a hard treatment - it is not an easy option by a long shot. It is very physically demanding. After injection of the Coley's vaccine the patient can develop severe chills, headaches, joint pain. This is followed by a prolonged fever, with high temperatures that are allowed to play themselves out rather than being damped down by anti-fever medication. The whole episode may last many hours, sometimes more than six hours before the temperature starts to come down. And then the treatment is repeated again - everyday, five days a week. For about six weeks. In terms of care it demands constant monitoring of the patient. The temperature needs to be tracked to make sure it doesn't lead to seizures. It's not a treatment that the patient can have while sitting in a chair and watching the TV.

None of this is apparent in the literature of Coley's. To read some articles one would think that it's just a case of having an injection and then feeling a bit hot. This is so far removed from the reality as to be laughable.

Dr Mannings has treated a number of other patients since George. The majority have not shown any great anti-tumour response. The good news, however, is that some have responded. We are continuing with these treatments and will be working on a number of case studies where there is radiological evidence of response - but we are being cautious and want to make sure that these responses are not just temporary. At some point in 2012, the plan is that Dr Mannings will publish these positive results in a peer reviewed medical journal.

Also worth noting is that following in a small number of patients, Dr Mannings started the Coley's treatment and then he has handed over to other doctors to continue the treatment. In this small number of cases we have palliative care consultants treating their patients with Coley's on the NHS, which is, I think a significant development and hopefully a good sign.

There are questions about the treatment still. Personally I believe the current protocol is too aggressive, and that treatment with Coley's three days a week is better than every day, and that intra-tumoural injection is preferable to intravenous, but these can be worked out in the future. For now, at least, we can say that we have seen the first positive responses to Coley's. My one regret is that we did not get the treatment to George when he might have been in a better position to benefit. But he was a pioneer and his experience with Coley's was not in vain if it has lead to other patients benefitting from what was learned in treating him.

3 comments:

I think its great Star Throwers are trying new things. I took my Dad to a clinic in Germany where they used Coleys, but they dont have such an aggressive therapy plan. its used about every 4 days for 4 weeks (obviously to suit the individual)